Solving the challenge of real time HCC coding for providers

Down in the trenches of Medicare Advantage primary care, most providers in the business know the importance of HCC coding. However, for the busy practitioner who is taking care of the patient and dealing with an alphabet soup of mandates such as HEDIS, STAR, HCAHPS etc, it is quite a task to pay attention to HCC coding in real time. As a result, providers fall short and have to answer then queries from coders re HCC codes that may have been missed.

The answer for this problem may lie in an EHR- integrated tool which can provide real time HCC medical coding guidance to the provider. Such a tool would intelligently analyze the chart as the provider is seeing the patient and suggest appropriate HCC codes. The provider could then add the codes and plan of care to the encounter, before leaving the exam room. We believe we have built just such a real time HCC coding tool called HCC Assistant. This application is integrated with multiple EHRs and through the integration it can receive the patient data in real time, analyze it against intelligent rules and suggest HCC codes, within seconds. It can analyze structured and unstructured data, which is great for folks who free text their notes. It can also look at lab results, imaging results etc, so it is analyzing the entire chart, not just encounter note.

For those not familiar with HCC medical coding and risk adjustment. HCC (Hierarchical Condition Category) codes are a subset of ICD10 codes that Medicare (and increasingly commercial payers as well) uses to determine the risk scores of Medicare Advantage patients. The sicker the patient, the more HCC codes they have and the higher the risk score. The higher the risk score is for a patient, the higher the predicted expenditure and therefore higher the payment to the health plan for that patient. As one can imagine, if a patient’s risk score does not reflect the patient’s condition due to inadequate coding, it can affect the plan’s bottom line and by extension the physician’s profile. Proper HCC medical coding is therefore critical.

We are hopeful that this intelligent hcc coding tool will help providers and their billing staff to do appropriate HCC coding which in turn will lead to accurate risk adjustment at CMS and health plan levels.